The region from phenylalanine-17 to phenylalanine-28 of a yeast mitochondrial ATPase inhibitor is essential for its ATPase inhibitory activity

Mitochondrial ATP synthase (F(1)F(o)-ATPase) is regulated by an intrinsic ATPase inhibitor protein. In the present study, we investigated the structure-function relationship of the yeast ATPase inhibitor by amino acid replacement. A total of 22 mutants were isolated and characterized. Five mutants (F17S, R20G, R22G, E25A, and F28S) were entirely inactive, indicating that the residues, Phe17, Arg20, Arg22, Glu25, and Phe28, are essential for the ATPase inhibitory activity of the protein. The activity of 7 mutants (A23G, R30G, R32G, Q36G, L37G, L40S, and L44G) decreased, indicating that the residues, Ala23, Arg30, Arg32, Gln36, Leu37, Leu40, and Leu44, are also involved in the activity. Three mutants, V29G, K34Q, and K41Q, retained normal activity at pH 6.5, but were less active at pH 7.2, indicating that the residues, Val29, Lys34, and Lys41, are required for the protein's action at higher pH. The effects of 6 mutants (D26A, E35V, H39N, H39R, K46Q, and K49Q) were slight or undetectable, and the residues Asp26, Glu35, His39, Lys46, and Lys49 thus appear to be dispensable. The mutant E21A retained normal ATPase inhibitory activity but lacked pH-sensitivity. Competition experiments suggested that the 5 inactivated mutants (F17S, R20G, R22G, E25A, and F28S) could still bind to the inhibitory site on F(1)F(o)-ATPase. These results show that the region from the position 17 to 28 of the yeast inhibitor is the most important for its activity and is required for the inhibition of F(1), rather than binding to the enzyme.

Interstitial pneumonia in Hermansky-Pudlak syndrome: significance of florid foamy swelling/degeneration (giant lamellar body degeneration) of type-2 pneumocytes

Although usual interstitial pneumonia (UIP)-like IP has been known as the most serious complication of Hermansky-Pudlak syndrome (HPS), its pathologic features and pathogenesis are poorly understood. We investigated biopsied and autopsied lung tissues from five patients who died of UIP-like IP associated with HPS (HPSIP). The salient histopathologic features of HPSIP observed were: (1) alveolar septa displaying florid proliferation of type-2 pneumocytes (2PCs) with characteristic foamy swelling/degeneration; (2) patchy fibrosis with lymphocytic and histiocytic infiltration centered around respiratory bronchioles, occasionally showing constrictive bronchiolitis; and (3) honeycomb change without predilection for the lower lobes or subpleural area. Those peculiar 2PCs were histochemically characterized by the over accumulation of phospholipid, immunohistochemically by a weak positivity for surfactant protein, and ultrastructurally by the presence of numerous giant lamellar bodies that compressed the nucleus with occasional cytoplasmic disruption, together suggesting a form of cellular degeneration with an over accumulation of surfactant (giant lamellar body degeneration). The present study strongly indicates that there is a basic defect in the formation/secretion process of surfactant by the 2PCs in HPS, which may well be the triggering factor for the HPSIP development. Other factors, such as macrophage dysfunction, may be working synergistically for further acceleration of the inflammatory process.

Leydig cell hyperplasia and the maintenance of bone volume: bone histomorphometry and testicular histopathology in 29 male leprosy autopsy cases

This study was conducted to determine if osteoporosis in male leprosy patients is caused by testicular atrophy. Bone volume (BV/TV), trabecular number (TbN), trabecular thickness (TbTh), and trabecular separation (TbSp) were measured in two areas in decalcified paraffin sections of lumbar bones from 29 male leprosy and 6 male nonleprosy autopsy cases. We found significant differences in the average BV/TV measurements among the 7 patients with nodular Leydig cell hyperplasia (BV/TV 12.24%) and the 22 patients without hyperplasia (BV/TV 7.35%) and 6 patients without leprosy (BV/TV 12.98%). Bone volume was maintained in patients with nodular Leydig cell hyperplasia, and we determined no clinical factor other than the Leydig cell hyperplasia that reflected the bone volume. The osteoporosis of male leprosy patients was attributed to secondary gonadal dysfunction due to testicular atrophy, and Leydig cell hyperplasia appears to preserve bone volume.

[A case of asymptomatic meningioma at left frontal convexity: evaluation using of WAIS-R at preoperation and postoperation]

The authors reported a case of 39-year-old man with incidentally found meningioma whose postoperative WAIS-R scores were improved significantly. He got a minor head injury run in a car collision and showed no neurological findings on admission. Computed tomography revealed no traumatic abnormalities but left frontal convexity meningioma. Total removal of the tumor was performed 3 weeks after the admission. Preoperative verbal IQ, performance IQ, lower full IQ were 105, 95, 100 respectively, and improved to 113, 112, 114 postoperatively. An asymptomatic patient with incidentally found meningioma could have higher brain function disturbances, which could be improved after its resection, therefore we should operate on such a patient more positively.

Neovascularization of the outermost area of herniated lumbar intervertebral discs

In 64 surgically treated herniated lumbar intervertebral discs, we performed histopathological studies of neovascularization in the outermost layer of the herniated mass in various types of hernia. We obtained specimens separately from the capsule tissue covering the herniated mass and the inner tip tissue of the herniated mass for comparison. Histologically, in most cases, the capsule tissue was the outermost layer of the annulus fibrosus or posterior longitudinal ligament, and the inner tip tissue was the nucleus pulposus. In the capsule tissue, newly formed small blood vessels were present in 73.4% of the total cases examined, regardless of the hernia type. However, the frequency and degree of such vessels in the tip tissue were significantly higher in hernias that perforated the posterior longitudinal ligament than in those that did not. When the intervertebral disc herniates, new blood vessels proliferate in the capsule of the hernial tissue. At the stage when the hernial capsule tissue is still present, these vessels were observed to have difficulty reaching the inner tip portion. These findings suggest that when the nucleus pulposus portion of the herniated mass perforates the posterior longitudinal ligament, it may be subject to a stronger neovascularization reaction.

Lymphoplasmacyte-rich meningioma: a case report with histological and immunohistochemical studies

This report concerns a 64-year-old woman with a lymphoplasmacyte-rich meningioma. Radiographically and macroscopically, the tumor had the appearance of an ordinary meningioma. Components of the meningothelial cells were positively immunostained for epithelial membrane antigen. The results of immunohistochemical assays with the antibodies to surface markers of lymphocytes L26 and UCHL-1 indicated that the lymphoplasmacellular proliferation was not neoplastic but probably represented an immune reaction of the host.

Osteoporosis due to testicular atrophy in male leprosy patients

A study was conducted to examine the relationship of testicular atrophy to bone metabolism in male leprosy patients. The study consisted of 31 leprosy patients (mean age: 62.0 years) and 31 healthy control men (mean age: 60.0 years). Measurements were made of their serum levels of free testosterone (FT), estradiol (E2), luteinizing hormone (LH) and 25-hydroxyvitamin D (25 OHD). Bone mineral density (BMD) was measured at radial sites and the lumbar vertebral bodies (L2-L4) by dual-energy X-ray absorptiometry using a Hologic QDR-2000 densitometer. FT and E2 levels were significantly lower and LH levels higher in leprosy patients than in controls. This represents a primary hypogonadal pattern. A value of 7.20 pg/ml of FT ( = Mean - 1 SD of control) was used as a cut off value, and the subjects were subdivided into a hypogonadal group (HG) and a non hypogonadal group (non-HG). When the subjects were compared for differences in age, age at onset of disease, duration of disease, body mass index and BMD, only the duration of disease and BMD were significantly different between the two groups. Furthermore, BMD of the forearm significantly correlated with FT levels (r = 0.689, P < 0.0001). Low BMD may be due to orchitis and testicular atrophy.

Prospective study of nesidioblastosis in newborns and infants: hypoglycemic seizures, epileptogenesis and the significance of the C-peptide suppression test in pancreatectomy

The long-term follow-up of chronic hyperinsulinemic seizures, epileptogenesis and other neurological complications in five patients who were treated with conservative therapy followed by pancreatectomy during the neonatal period and infancy, who were confirmed to have diffuse nesidioblastosis are described. The reaction pattern of the C-peptide (CPR) suppression test and its relation to the final extent of pancreatectomy was examined in four patients. The chronological change in electro-encephalography (EEG) and its epileptogenesis was also examined in each patient during hyperinsulinemic hypoglycemia, and during normoglycemia in a long-term post-pancreatectomy follow-up. All patients demonstrated several types of hypoglycemic seizures, ranging from apnea, erratic seizures, evolving to generalized/unilateral tonic-clonic or tonic seizures, myoclonic seizures and EEG abnormalities. Four of five patients still suffered from epilepsy at the age of 4-22 years. The reaction pattern of the CPR suppression test showed dichotomy, with a hyper-reactive pattern in two patients who required total pancreatectomy to control hypoglycemia, and a suppression pattern in two other patients treated with 90-95% pancreatectomy. Neonatal onset and subsequent myoclonic seizures were ominous signs of epileptogenesis to various types of intractable epilepsy and other neurological sequelae. A prompt diagnosis and pancreatectomy of a sufficient extent at the first operation are essential. The CPR suppression test may be useful for a prompt diagnosis and selection of the extent of pancreatectomy.

Intracranial germinoma with Down's syndrome: a case report and review of the literature

BACKGROUND

Down's syndrome's association with malignancies such as leukemia is well known, but its association with brain tumor appears to be rare. We reviewed such rare cases of Down's syndrome and intracranial germ-cell tumor.

CASE REPORT

A 10-year-old boy with Down's syndrome and intracranial germinoma located in the left basal ganglia is reported. The patient presented with right hemiparesis and was treated with a combination of surgery, chemotherapy with cisplatin and etoposide, and irradiation.

CONCLUSIONS

We speculate that the percentage of germ-cell tumors is high among Down syndrome patients with brain tumors and that the most common site is the basal ganglia.

Hantavirus infection among Rattus norvegicus in Japan

Seroepizootiological study of hantavirus infection among 393 urban rats (Rattus norvegicus) captured in six regions in Japan during the period from 1990 to 1994 was carried out by the indirect fluorescent antibody (IFA) test and Western blot (WB). Fifteen out of 393 (3.8%) rat sera were antibody-positive by IFA, i.e., Tokyo Port (12.8%, 6/47), Shimizu Port (5.7%, 2/35), Otaru Port (1.5%, 1/65) and Nagoya City (3.6%, 6/167). In two other regions, i.e., Kasai Seaside Park and Haneda Airport, rat sera were antibody-negative. One serum with a lower IFA titer, 1:64, from Otaru Port was confirmed to be antibody-positive by WB, while two sera from Shimizu Port (IFA titer, 1:32 and 1:64) were not. In Nagoya City, one out of four sera (IFA titer, 1:32) and one of two sera (IFA titer, 1:64) were also confirmed to be antibody-positive by WB. Continuous hantavirus infection among rats in Tokyo Port, Shimizu Port and Nagoya City and the existence of hantavirus among rats in Otaru Port were demonstrated.

Idiopathic peripheral neuropathy in a horse with knuckling

We report the pathological findings of the skeletal muscle and peripheral nerves from a male 14-months-old thoroughbred horse showing idiopathic knuckling. The affected animal, when in staining position, presented knuckling at the fetlock joint of both forelegs, and dragged both fore- and hindlegs when attempting forward movement. The skeletal muscles demonstrated neurogenic atrophy characterized by the scattering of single angular fibers, groups consisting of five to ten angular fibers, and multiple fascicles of atrophic and hypertrophic fibers. The severity of changes tended to be a distal gradient. While there was no evidence of fiber loss on light microscopy, a diffuse scattering of myelin ovoid, Wallerian-like degeneration and onion-bulb formations were observed in almost all peripheral nerves collected. The characteristic features in electron microscope were swollen axons, which contained accumulations of organelles, especially degenerative mitochondria and neurofilamanets. Onion-bulb formations were frequently found and were associated with Schwann cell processes and occasional collagen pockets. Other prominent feature were Büngner bands which contained myelin debris and regenerating axons or sprouts. These findings suggested that the nature of this disease was a disturbance in axonal transport and were indicative of a distal axonopathy.

[The efficacy and safety of priming principle with pipecuronium]

The authors evaluated the cumulative dose response of pipecuronium under isoflurane anesthesia, and the efficacy as well as safety of priming principle in 52 patients who underwent elective surgery. The ED95 of pipecuronium was 34.24 +/- 5.34 micrograms.kg-1 in 10 patients and 70 micrograms.kg-1 (not equal to ED95 x 2) was used as total dose (T). The 42 patients were divided to receive either no prime or, 5%, 10%, 15% or 20% of T as a prime followed 5 minutes later by the remaining (intubating) dose. The muscle weakness in awake patients was determined after the priming doses by examining several clinical symptoms and by evaluating the effect of intubating doses on neuromuscular blockade. The priming using 10% of T provided rapid intubating conditions. However, the priming dose caused a significant incidence of symptoms of muscle weakness. Therefore, the priming principle should be used with caution.

Effect of preanesthetic intramuscular ranitidine on gastric acidity and volume in children

STUDY OBJECTIVE

To evaluate the effects of preanesthetic administration of intramuscular (IM) ranitidine on pH and volume of gastric contents in children.

DESIGN

Three randomized treatment groups.

SETTING

Central operating rooms at a university hospital.

PATIENTS

Forty children age 1 to 10 years undergoing a variety of elective surgical procedures requiring general anesthesia with endotracheal intubation.

INTERVENTIONS

IM ranitidine 1 mg/kg (n = 15) or 2 mg/kg (n = 15) was administered 2 hours prior to induction of anesthesia. Ten patients without ranitidine served as the control group. An orogastric tube was inserted into each patient.

MEASUREMENTS AND MAIN RESULTS

Gastric fluid pH and volume were measured every hour in the three groups. Plasma ranitidine concentrations were measured in ten patients of the ranitidine-treated groups. The mean volume of gastric fluid at induction of anesthesia was significantly lower in the ranitidine-treated patients (2.4 ml for ranitidine 1 mg/kg, 3.2 ml for ranitidine 2 mg/kg) than in the controls (8.6 ml; p less than 0.05). The mean pH values at induction of anesthesia were significantly higher in the ranitidine-treated patients (4.6 for 1 mg/kg, 6.7 for 2 mg/kg) than in the controls (2.1; p less than 0.05). Dose-dependent plasma ranitidine concentrations were obtained.

CONCLUSIONS

Preanesthetic IM ranitidine 1 to 2 mg/kg resulted in a higher pH and lower volume of gastric fluid at the time of induction and in a higher pH during 3 hours of anesthesia. This therapy may be a useful adjunct to premedication for children who have a greater than normal risk of pulmonary aspiration during anesthesia.

A girl with Hermansky-Pudlak syndrome

A young girl with ocular albinism and the Hermansky-Pudlak syndrome is described. Ocular albinism generally occurs in males. In this condition, the pigmentation of the skin and hair is nearly normal, and the melanin pigment abnormality is limited to the eyeballs. The chief complaints are visual disturbance, nystagmus, and photophobia. A 3-year-old girl was recently brought to our hospital with nystagmus, which she had exhibited since the age of 1 year. Funduscopy resulted in a diagnosis of ocular albinism. Further investigations, specifically, microscopy of her platelets, led us to conclude that she had Hermansky-Pudlak syndrome.

Structure of the [2Fe-2S] ferredoxin I from the blue-green alga Aphanothece sacrum at 2.2 A resolution

Crystals of a [2Fe-2S] ferredoxin (Fd) I with a relative molecular mass of 10,480 were obtained from the blue-green alga Aphanothece sacrum. Each asymmetric unit of the crystal contains four molecules. An electron density map calculated by the single isomorphous replacement method with the anomalous dispersion at 2.5 A resolution was refined by averaging the four molecules in the asymmetric unit. Positional and isotropic thermal parameters for the non-hydrogen atoms of the four molecules and 158 water molecules were refined to an R-factor (R = sigma[Fo-Fc[/sigma Fo) of 0.23 by the restrained least-squares method. The estimated root-mean-square (r.m.s.) error for the atomic positions is 0.3 A. The r.m.s. deviations of equivalent C alpha atoms of the asymmetric-unit molecules superposed by the least-squares method average 0.35 A. The Fd molecule has a structure like the beta-barrel in the molecule of the [2Fe-2S] Fd from Spirulina platensis. A [2Fe-2S] cluster is bonded covalently to the protein molecule by four Fe-S, in which three of the Fe-S bonds are in a loop segment from position 38 to 47. The hydrophobic core inside the beta-barrel is formed by seven conservative residues: Val15, Val18, Ile24, Leu51, Ile74, Ala79 and Ile87. The molecular surface around Tyr23, Tyr80 and the active center may interact with ferredoxin-NADP+ reductase. One of the two iron atoms of the [2Fe-2S] cluster should be more easily reduced than the other because of differences in the hydrogen-bonding scheme and the hydrophobicity around the atoms.

[The effects of ulinastatin on the release of granulocyte elastase during pancreas surgery]

During a major abdominal surgery, intraoperative manipulation may cause circulatory changes, which lead to release of granulocyte elastase. Twenty one patients were studied to elucidate the release of granulocyte elastase and the inhibitory effect of a protease inhibitor (ulinastatin) on lysosomal enzyme release during pancreas surgery. Patients were divided into 3 groups. Patients in group A served as control. Patients in group B were given ulinastatin 10,000 units.kg-1 intravenously prior to surgery. Patients in group C were given ulinastatin 5,000 units.kg-1 intravenously twice prior to surgery and 3 hours after the start of surgery. The granulocyte elastase was measured by commercially available kits, at 7 points: prior to induction of anesthesia, immediately after tracheal intubation, 30, 60, 120, 180 min after the start of surgery and 30 min after surgery. The plasma level of elastase increased markedly during the operation in group A, it did not increase in groups B and C during the operation. Thirty min after the operation, the plasma level of elastase increased markedly in group A (354 +/- 63 micrograms.l-1), and in group B (396 +/- 167 micrograms.l-1). The plasma level of elastase was restored to normal levels 30 min after the operation in group C. These results indicate that granulocyte elastase values were maintained at significantly higher levels during and after pancreas surgery, and suggest that ulinastatin inhibits the release of granulocyte elastase during pancreas surgery.

[Effects of dichloroacetate in the ischemic heart. Analysis of hemodynamics, myocardial energy metabolism and myocardial pH]

The effects of dichloroacetate (DCA), which is known to have a beneficial effect on lactic acidosis, were examined on myocardial acidosis during coronary occlusion in dogs. Ischemia was induced by complete ligation of the left anterior descending coronary artery (LAD) of the open-chest dog heart. DCA 100 mg/kg or 200 mg/kg was administered intravenously 10 or 60 min prior to the occlusion of LAD. DCA did not change the LAD flow, decreased heart rate, increased both systolic and diastolic blood pressures transiently. LAD occlusion significantly increased the ST segment of the epicardial ECG in the saline-treated group. DCA administered prior to the LAD occlusion caused 50% decrease of the elevation in ST segment during ischemia. Ischemia accelerated anaerobic metabolism in the myocardium; the levels of glycogen, adenosine triphosphate (ATP) and creatine phosphate (CP) decreased, and lactate increased during ischemia. Calculated energy charge potential was decreased, and [( G6P] + [F6P])/[FDP] ratio was increased by ischemia. The decreased levels of glycogen, ATP, CP in DCA-treated group were similar to those in saline-treated group during 3 min ischemia. Pretreatment of DCA reduced the accumulation of myocardial lactate by ischemia. There were no differences in variables except myocardial lactate levels between DCA 100 mg/kg and 200 mg/kg. The myocardial lactate levels were lower in both nonischemic and ischemic dogs by DCA 200 mg/kg than DCA 100 mg/kg. DCA did not change either the ATP levels or energy charge potential during both ischemia and reperfusion. LAD occlusion caused a significant decrease of myocardial pH from 7.51 to 6.83 in saline-treated group, while it produced only a small decrease in DCA-treated group from 7.56 to 7.35.(ABSTRACT TRUNCATED AT 250 WORDS)

Two serogroups of Vibrio cholerae non-O1 possessing somatic antigen factors in common with Hakata serogroup of V. cholerae

Two serogroups of Vibrio cholerae non-O1 possessing somatic antigen factors in common with Hakata serogroup of V. cholerae are described. One group was included in the Hakata serogroup and has its own antigen other than all O-antigens of the Hakata group. The other group had its own major antigen, but not factor F specific for the Hakata group.

Comparative inotropic effects of local anesthetics in isolated cat papillary muscles

The direct inotropic action of seven local anesthetics: procaine, mapivacaine, lidocaine, tetracaine, chloroprocaine, bupivacaine and etidocaine were compared in isolated cat papillary muscles. All of the local anesthetics produced a dose-related depression of maximal velocity of shortening (Vmax), maximal developed force (Fm) and maximal dF/dt. The more potent local anesthetics such as bupivacaine and etidocaine depressed myocardial contractility at significantly lower concentrations than the less potent local anesthetics such as lidocaine and mepivacaine. Depression of Vmax by bupivacaine or etidocaine was three times greater than that by lidocaine and ten times greater than that by procaine. At the same concentration (10(-4) M), direct myocardial depression was demonstrated in the following order of severity: etidocaine >/= bupivacaine >> tetracaine >> chloroprocaine >/= lidocaine >> mepivacaine >> procaine.

[Acinic cell tumor of the bronchial gland]

The patient was a 29-year-old male with a history of recurrent pulmonary infection for the past two years. Bronchoscopy showed complete obstruction of the left sixth bronchus by a submucosal tumor. Biopsy of the tumor revealed clear cell neoplasia suggesting bronchial gland origin. Left sixth segmentectomy was done. Grossly, the tumor was 1.5 cm in diameter, solid, yellowish white in color, round in shape and protruding into the lumen and covered by the bronchial mucosa. The lung tissue and mediastinal lymph nodes were free of tumors. Histologically, the tumor consisted of sheets of clear or granular basophilic cells. Mucicarmine-negative, diastase-resistant PAS positive granules were evident in the tumor cells. Immunohistochemical stain of amylase (salivary gland type) was positive in the tumor cells. Multiple psammoma bodies were present. Histological diagnosis was acinic cell tumor of the bronchial gland. The patient is alive and well one year after removal of the tumor.

Continuous mixed venous oxygen saturation monitoring during general anesthesia

Clinical evaluation of continuous SvO2 monitoring during general anesthesia was made in 21 surgical patients utilizing a fiberoptic reflectometry system combined with a pulmonary artery flow-directed balloon catheter. On-line in vivo values for SvO2 by the system were closely related to those obtained in vitro from a Radiometer ABL-300. There was a good correlation between changes of in vivo SvO2 and corresponding changes in cardiac index. We also observed that there were significant correlations between SvO2 and oxygen extraction ratio, and SvO2 and oxygen delivery. These data indicate that continuous monitoring of SvO2 during general anesthesia can provide on-line information not only about hemodynamic state but also on oxygen transport, which will be especially helpful in managing hemodynamically unstable patients during anesthesia.

[Primary malignant mesothelioma of the pericardium masquerading as malignant pleural mesothelioma: report of an autopsy case and review of the reported cases in Japan as to its invasion to neighboring organs]

The Patient was a 72-year-old man who presented with dyspnea and general fatigue. Chest X-ray and CT-scan at the admission showed bilateral pleural effusion with collapse of the left lung and pericardial effusion. Cytology from the left pleural effusion suggested malignant mesothelioma. For this reason, malignant mesothelioma of the left pleura was diagnosed clinically and it was supposed to have spread subsequently to the pericardium. At autopsy, entire surface of the heart was found to be encroached in a diffuse fashion by a thick layer of mesothelioma tissues, which formed a small mass around the left pulmonary vein over the left atrium and invaded deep into the myocardium of all cardiac chambers. The endocardium and the intima of the left pulmonary vein were free of the invasion. The parietal pericardium adhered in places to the cardiac lesion, but no direct invasion to the adjacent pleurae through the pericardial wall was present. The left pleura over the lung and chest cavity disclosed only a superficial invasion by similar mesothelioma which was identifiable only on microscopic study. No distant metastasis was present in any thoracic and other organs as well as lymph nodes including the hilar ones of the lung. It seemed most likely from this anatomical finding that the primary site of the present mesothelioma was in the pericardium (visceral) and the tumor spread to the left pleura by a continuous extension along the outside of the left pulmonary vein. Primary malignant mesothelioma of the pericardium is of very rare occurrence and we found only 51 cases of it in the Japanese literature since 1915.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical evaluation of continuous venous oxygen saturation monitoring during anesthesia

Clinical evaluation of continuous SvO2 monitoring during anesthesia was made in 14 surgical patients utilizing a fiberoptic reflectometry system combined with a pulmonary artery flow-directed balloon catheter. On-line values for SvO2 by the system were closely related to those obtained in vitro from a Radiometer ABL-300. There was a good correlation between changes of in vivo SvO2 and corresponding changes in cardiac index. We also observed that there was a significant correlation between SvO2 and oxygen extraction ratio. Our data indicate that continuous SvO2 monitoring during anesthesia can provide on-line information not only about hemodynamic state but also on oxygen transport.

[A case of oral florid papillomatosis combined with gastroduodenal polyposis]

A 49-year-old man developing numerous papillary or partly cauliflower-like tumors over the lips, oral angles, gingiva and tongue starting 15 years earlier and associated with multiple gastroduodenal polyps of various sizes revealed by X-ray examination is presented. Histologically, the oral lesions consisted of marked proliferation of mature squamous cells without appreciable cellular atypism or submucosal invasion. Electron microscopic study failed to detect any virus-like particles, and negative reaction was obtained in immunohistological study for papilloma virus. The association of gastroduodenal polyposis with oral florid papillomatosis has appeared very rarely in the literature. Although the relationship between the two lesions remains unknown, it was assumed in the present case that all lesions would represent an entity of a hamartomatous nature.

Sessile adenoma of the gallbladder. Reappraisal of its importance as a precancerous lesion

Three hundred gallbladders from patients with cholelithiasis were examined under a dissection microscope. Sixteen (5%) were found to have what have been called sessile adenomas. They consisted of mixtures of hyperplastic lining epithelium and metaplastic mucous glands, and their interstitium often included smooth-muscle fibers. Small foci of moderately severe cellular atypism were present in 19% of the adenoma cases, but none had definitive evidence of malignancy. Carcinoembryonic antigen was demonstrated in hyperplastic lining epithelium with or without cellular atypism in 31% of the cases. Sessile adenomas most likely represent reactive overgrowth and therefore we prefer to term them hyperplastic polyps.

[A case of malignant schwannoma of the mesentery in a patient with von Recklinghausen's disease]

A 23-year-old man with Von Recklinghausen's disease was admitted because of abdominal pain. The preoperative diagnosis was malignant mesenteric tumor. Laparotomy was done and the tumor was located in the mesentery of the ileum which showed numerous tortuous cords or bulbous projections from the surface. Partial resection of the involved ileum and the mesentery was performed. Histological examination revealed plexiform neurofibroma and malignant Schwannoma of the mesentery. It is very difficult to preoperatively diagnose early associated lesions of Von Recklinghausen's disease. Therefore, careful examination of the GI tract is important so that earlier therapy can be carried out.

[Minute gallbladder cancer--case report with suggestions regarding a possibly unique histogenesis]

A 35-year-old woman with minute gallbladder cancer is presented. Cholecystectomy for gallstones resulted in recurrent colic lasting for a few years. Examination of the resected bladder under a dissection microscope disclosed a minute polypoid tumor with cylindroid appearance measuring 2.0 X 0.5 mm; it was located on a thin membraneous stalk in the neck region. Histologically, the tumor consisted chiefly of well-differentiated adenocarcinoma, in its periphery there were adenomatous residues; the stalk was free of neoplastic change. Blood group substances were completely absent in the cancerous tissues, they were present in adenomatous tissues. We hypothesize that the present cancer derived from the minute gallbladder adenoma via malignant change at an early stage development, suggesting a unique mode for an adenoma-carcinoma sequence in the gallbladder. The present case is believed to be the smallest cancer among reported cases and we propose to define minute gallbladder cancer as that less than 5 mm in maximum diameter.

Myxopapillary ependymoma of the lateral ventricle. A study on the mechanism of its stromal myxoid change

Reported was the first case of myxopapillary ependymoma arising from the right lateral ventricle of a 29-year-old Japanese male. The histological and ultrastructural findings were identical to those from the filum terminale. It was suggested that insudation of plasma proteins found within hyaline-thickened blood vessels in the tumor stroma represented the presence of previous long-standing anoxia and thus, circulatory disturbance would be closely related to the formation of the stromal myxoid change.

Adult T-cell leukemia with generalized cytomegalic inclusion disease and pneumocystis carinii pneumonia

An autopsy case of adult T-cell leukemia with generalized cytomegalic inclusion disease and pneumocystis carinii pneumonia is reported. Tumor cells had T-cell characteristics (E-rosette) and cerebriform nucleus similar to Sèzary cells. Generalized lymphadenopathy, hepatosplenomegaly and an ectopic pancreas in the ileum were found at the time of autopsy. Histologically, leukemic infiltration was observed in almost every organ, and perivascular infiltration, vascular invasion were conspicuous findings. Cytomegalic inclusion bodies were observed in most organs (lungs, salivary glands, pancreas, liver, ectopic pancreas, sweat gland, stomach, thyroid gland, pituitary body, etc.). An acute hepatitis, probably caused by cytomegalovirus, was also noted. Presumed correlation of adult T-cell leukemia, cutaneous T-cell lymphoma and T-cell lymphoma was discussed.